Jason Lantz White, IDMT
Individual provider Active NPI Independent Duty Medical Technicians · Moody a F B, GA
NPI 1689946071 · NPPES record last updated Feb 1, 2012
Key facts
- NPI
- 1689946071
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Independent Duty Medical Technicians 1710I1003X
- Practice address
- 3280 Mitchell Blvd
Moody a F B, GA 31699-1500 - Phone
- (229) 257-2105
- NPI assigned
- Feb 1, 2012
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Independent Duty Medical Technicians | 1710I1003X | Yes |
Addresses
Primary practice location
3280 Mitchell Blvd
Moody a F B, GA 31699-1500
Mailing address
3807 Robin LN
Valdosta, GA 31605-5124
Phone (229) 560-1598
Other providers in Moody a F B, GA
All providers in Moody a F B, GA · Independent Duty Medical Technicians in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 1, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.